Unknown Individual – Emergency Medicine Physician, NPI 1790761161
Emergency Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
2619 SUMMER RAIN DR
MANVEL, TX 77578
Phone: (832) 335-0835
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $188.
Total Amount is formed as General ($188) + Research ($0) + Ownership ($0) = $188.
Last reported payment date: 2023-11-09 • Largest payer in this snapshot: Merz North America, Inc. ($188).
Total Amount
$188
General + Research + Ownership
Payments
1
Total payment records
General Amount
$188
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-11-09
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Merz North America, Inc. | $188 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-06-14
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040614000963 | I | Emergency Medicine | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99285 | Emergency department visit with high level of medical decision making | 11 | 11 | $0 |
Insurance plans in this area (ZIP 77578)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| EMERGENCY MEDICINE | TX | 93010 | Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report | 49 | 48 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | TX | |
| Nurse Practitioner | TX | |
| - | TX | |
| - | TX | |
| Nurse Practitioner | TX | |
| Physician Assistant | MS | |
| Physician Assistant | TX | |
| Nurse Practitioner | MS | |
| Nurse Practitioner | TX | |
| Nurse Practitioner | TX |
Reviews
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